“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.” – Leo F. Buscaglia

(This blog post previously appeared in HealthAndCare.scot. You can throw me a tip to support this blog here.)

Common Weal has spent four years campaigning hard for a National Care Service (NCS) that would be as worthy of that name as we all believe that the National Health Service should be of its name.

When the initial National Care Service (Scotland) Bill was published and introduced we were so concerned with the lack of vision and purpose and with the massive ministerial power grab contained within it, we successfully campaigned alongside the Scottish Trade Union Congress to get the Bill paused so that we could have a thorough period of co-design with various care stakeholders to bring the Bill up to worthy standard.

Despite many hundreds of hours spent collectively by dozens of organisations across Scotland, progress from the Scottish government remained slow and even at times counterproductive.

The Verity House Agreement of summer 2023, which resulted in the government “sharing” control of the NCS between COSLA and the NHS, was a deal done outwith the co-design process and behind closed doors with most stakeholders only catching wind of it at all after it had been signed and sealed. Even many of those who broadly agreed with the principle of the deal were appalled at the undermining of trust in the co-design process that it represented, especially after the government couldn’t assure us that future deals of this nature wouldn’t be ruled out.

The result – for good or ill – of the co-design pause was that the Bill itself was no longer fit for purpose as things like the Verity House Agreement directly contradict sections of the Bill as written (in this case, the principle of direct and centralised ministerial control of the NCS).

Despite the Scottish government promising to bring forward amendments that would rectify this, it instead set up an Expert Legislative Working Group (ELAG) to scrutinise those amendments first. As has since been reported, the ELAG was not presented with the amendments, which clearly hadn’t been written, and was instead asked to comment on more general principles of care.

Common Weal has decided to create our own list of amendments to the Bill in our new policy paper “Fixing the National Care Service Bill”. Our ambition for the NCS goes far beyond that of the government’s and thus so do our amendments.

But we believe that it is still possible to reach for that ambition and to amend the Bill into something better than we will have even after the government publishes its amendments.

One of our first major insertions into the Bill is to describe the purpose of the NCS – to support a caring society and caring relationships, and to provide care directly where needed from cradle to grave – to protect the NCS from future changes that may run contrary to why we’re so invested in care in the first place.

Second are our core principles that care should be run free at point of need, on a not-for-profit basis, provided based on needs (including identifying unmet needs) and outcomes, and designed to benefit communities as well as individuals. This principle-led approach is a substantial distinction from the government’s proposals but one that goes almost unquestioned when we think about the purpose and founding principles of the NHS.

Our largest structural change is one that overturns the completely centralised (or, post-Verity, only reluctantly and partially decentralised) role of ministers in the NCS.

Rather than Ministers having complete diktat over care, we believe care should be managed from the ground up – literally starting from the relationship between cared for and carer.

Local care boards reporting to local authorities should be responsible for care in their area and those boards should elect people up into the National Care Board (instead of ministers appointing them from the top down).

Ministers, acting after consultation with the Board, may create special care boards for extraordinary purposes but these boards would also report to the National Care Board rather than ministers directly. In this way, Ministers have overall responsibility and accountability for the NCS and can set broad strategic goals but care itself should be managed and delivered by those who understand care best.

This is our last-ditch attempt to try to improve the prospects of a Scottish National Care Service within the limits set by parliamentary procedure. If our amendments are not accepted or if those of other groups do not bring the NCS into a worthy state, then we will have no choice but to campaign for the legislation to be voted down at stage two or stage three and for the government to be sent back to think again.

We know that there are others who are dissatisfied with the way that the government has used but ignored us and our attempts to improve the situation. We welcome any and all comment on our own proposals and if any care stakeholders are planning to publish their own proposals or amendments to the Bill – even if they contradict ours – then please get in touch and we’d be happy to host and co-ordinate a library of amendments that may allow politicians to help craft their vision of the future of care in Scotland.

Almost all of us, at some point in our lives, will need care or will deliver care. We deserve a National Care Service that helps us do both.